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Published on: January 15, 2017
Decision making in trauma settings: simulation to improve diagnostic skills
David J Murray1, Brad D Freeman, John R Boulet
1From the Howard & Joyce Wood Simulation Center (D.J.M., J.W.), Department of Anesthesiology (D.J.M., J.J.F.), Department of Surgery (B.F., M.K.), Washington University School of Medicine, St. Louis, MO; and Foundation for Advancement of International Medical Education and Research (J.R.B.), Philadelphia, PA.
Simulation training can improve trauma team diagnostic skills. Teams performed better on heuristic scenarios than analytic ones, suggesting simulation can enhance decision-making in critical care settings.
Area of Science:
- Medical Education
- Trauma Care
- Diagnostic Decision-Making
Background:
- Diagnostic errors in acute injury settings can be life-threatening.
- Overreliance on heuristics can lead to diagnostic errors.
- Simulation is proposed to improve diagnostic skills and heuristic awareness.
Purpose of the Study:
- To determine if simulation can provide teams experience with heuristic and analytic diagnostic skills.
- To assess simulation's utility in recognizing heuristic limitations and improving diagnostic accuracy.
Main Methods:
- Ten trauma scenarios were developed (7 standard/heuristic, 3 complex/analytic).
- Twenty-one teams of 3-5 residents managed randomly selected scenarios.
- Expert raters used checklists and global scores to evaluate team performance.
Main Results:
- Teams scored higher on heuristic scenarios (83.2%) than analytic scenarios (73.8%).
- Global scores were better for heuristic (6.6) versus analytic (5.9) scenarios (P < 0.05).
- Junior resident-led teams scored higher on analytic scenarios than senior-led teams.
Conclusions:
- Simulation effectively provides decision-making experiences in trauma settings.
- Simulation can be used to improve diagnostic skills and study decision-making processes.
- Team performance varied based on scenario complexity and leader experience, highlighting the need for tailored training.
